摘要:

Intravenous caffeine sodium benzoate (CSB) has been shown to be effective in relieving postdural puncture headache (PDPH). To assess if oral caffeine, a more convenient and cheaper approach, would also be effective, the authors evaluated postpartum patients who developed symptoms consistent with PDPH.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A group of 24 healthy parturients having elective cesarean section under epidural anesthesia with lidocaine with epinephrine were randomly divided into 2 groups. All patients simultaneously received an IM dose of 1 ml of solution and a 10 ml bolus via the epidural catheter. The coded ampules employed contained solutions prepared so that 11 patients received IM saline and 5 mg of morphine in 10 ml of solution epidurally, while 13 patients received 10 ml of epidural saline and 5 mg of IM morphine. Following drug injection at patient request, all patients were continuously monitored by pulse oximetry and respiratory inductive plethysmography so that respiratory rate and any apneic episodes were noted. Other observations were made of blood pressure, somnolence, pain, and presence of nausea, vomiting or pruritus. Side effects were treated as requested by diphenhydramine, dimenhydrinate and/or naloxone.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In order to compare the analgesic efficacy of epidural and IM meperidine following cesarean section, the authors studied 30 patients scheduled for elective cesarean section under epidural anesthesia produced by 0.5% bupivacaine. At the end of surgery, all extradural catheters were left in place, and patients received, within 30 minutes of the end of surgery from coded ampules, both an epidural injection of saline with or without 50 mg of meperidine and an IM injection of saline with and without 100 mg of meperidine. Thereafter, following pain assessment by a VAS, patients received “on demand” paired injections from coded ampules. Side effects were noted and treatment continued for 24 hours, at which time the catheter was removed.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 29-year-old secundigravida with twin gestation required cesarean section at 39 weeks' gestation because of severe bradycardia of the second twin. Her BP had risen from 110/60 mmHg on admission to 140/90 mmHg at 5 cm dilation of the cervix. The operation performed under general anesthesia was uneventful except for increased oozing from uterine and dermal incisions. Clotting function tests were within normal limits. Three hours after surgery, HR rose to 140 beats/min, hematocrit and hemoglobin declined to 19.5% and 6.5 mg/dl respectively, and thrombocytes fell to 20,000/mm3. PT was 24 sec, aPTT was 124 sec and fibrinogen 74 mg/dl. Treatment with packed cells, fresh-frozen plasma, cryoprecipitate and platelets ameliorated the clotting disturbance. Oliguria appeared 10 hours after operation and blood urea nitrogen rose to 9.6 mmol/l. Jaundice developed with total serum bilirubin of 197 mmol/1 and blood glucose of 1.2 mmol/1. Twenty-four hours later, the abdomen became increasingly distended; on laparotomy, 2,000 ml of bloody fluid was removed from the peritoneal cavity and the liver was enlarged, hard, and darkly discolored. Blood replacement was adequate. Peritoneal dialysis was started, liver enzyme levels began to rise markedly; metabolic acidosis was severe. The patient died on the 4th postoperative day in a state of active DIC with fulminant hepatorenal failure.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 19-year-old G1P0 was hospitalized in her 31st week of pregnancy with a 2-day history of abdominal pain which was diagnosed as acute appendicitis. While receiving MgSO4infusion to treat preterm labor, she underwent appendectomy under uneventful spinal anesthesia. 12 hours later, she developed marked tachypnea of 40–50/min and ABGs showed significant hypoxemia (PaO2= 42 mmHg on room air). In the SICU, PaO2on 100% oxygen by mask was 83 mmHg and after CPAP failed to improve ventilation, she was intubated. Fetal monitoring showed good fetal parameters. With PEEP settings of 10 cmH2O, PaO2was 60 mmHg with an FIO2of 0.4, with chest radiogram indicating extensive bilateral pulmonary edema despite a PCWP of 15 mmHg. She was delivered vaginally with IV meperidine only for analgesia 62 hours after appendectomy. Despite a transient episode of desaturation at delivery, requiring an FIO2of 1.0 for correction, the patient's ventilatory status improved steadily, permitting extubation 18 hours postpartum. At delivery oxygen consumption and intrapulmonary shunting were maximal. After delivery Qs/Qt fell from 28% to 8–13%, SaO2rose from 86.1 to 97.4% with an FIO2of 0.4, and oxygen consumption fell from 209 ml O2/min/m2to 125 ml O2/min/m2.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 28-year-old nullipara, paraplegic since birth, entered the hospital at 41 weeks' gestation in early labor. At 35 weeks, she had required treatment for a weeping decubitus ulcer. On admission, she was diaphoretic and anxious with BP of 210/105 mmHg, HR 100 beats/min, RR 24 breaths/min, and FHR 140 beats/min. The urine did not contain protein. After an IV preload, an epidural catheter was placed and 0.08% bupivacaine bolus injections begun. BP declined to 130/78 mmHg and anxiety resolved. The first stage lasted 6 h and was uneventful. One hour into the second stage, she was taken to the delivery room for an elective low-forceps delivery. The patient became anxious and diaphoretic again, her BP rose to 220/110 mmHg, and her upper extremities became hyper reflexic. IV labetalol 1 mg relieved the episode of autonomic hyperreflexia. The newborn had good Apgar scores and cord blood pH values.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The hyperimmunoglobulin E (HIE) syndrome, also known as Job's syndrome, is a rare disorder associated with recurrent bacterial infections and abscesses, usually withS. aureus, of the skin and respiratory tract. The primary immune defect is unknown and there is no effective therapy for prevention of recurrent infections. The authors dealt with a 21-year-old G2P1 with a history of HIE presenting during the 38th week of pregnancy with a painful right hip. When aspiration of the hip joint producedS. aureus, she was treated with antibiotics and then scheduled for hip abscess drainage. On arrival in the OR, after having refused oral antacids, the patient was monitored routinely with the addition of uterine contraction and FHR monitors. The patient was supine and had a right hip wedge placed. Rapid sequence induction with cricoid pressure was performed with thiopental-succinylcholine, and anesthesia was maintained with N2O-O2-isoflurane-atracurium. Save for some transient uterine contractions and FHR decelerations, the course was uneventful. 2 weeks later the patient had a normal vaginal delivery. The next ten months were complicated by thigh abscess, pneumonia, temporal abscess, and empyema.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A repeat emergency cesarean section was performed on a 32-year-old term-pregnant woman who admitted to abusing both alcohol and cocaine but denied use of cocaine for the past 3 days. Guillain-Barré syndrome had been diagnosed 8 weeks earlier on the basis of leg weakness and inability to walk but had resolved 3 weeks before hospital admission. Physical examination revealed a malnourished appearance with reduced muscle mass in all extremities. No laboratory data were available. General anesthesia was chosen and was induced with thiopental 250 mg followed by succinylcholine 100 mg in rapid sequence. Proper placement of the endotracheal tube was documented by auscultation and capnography. Less than 60 seconds after intubation, the previously normal ECG changed to a slow wide complex trace without p-waves. All anesthetics were discontinued, 100% O2administered and lidocaine 60 mg injected IV. Soon the ECG changed to a coarse trace and no pulse was palpable. CPR was begun. The infant was delivered within 3 min of the start of resuscitation with Apgar scores of 8 and 9 at 1 and 5 min, respectively.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 39-year-old female requiring repeat cesarean section presented with a history of chronic hypertension and primary hyperparathyroidism requiring no treatment. Following prehydration, a T4level epidural anesthetic was produced with 0.5% bupivacaine. The patient was placed supine on a level OR table with left uterine displacement and routine monitoring, including a precordial ultrasonic Doppler, was performed. Immediately after surgical incision, during subcutaneous dissection, the Doppler signal changed to one consistent with venous air embolism, and the patient complained of chest pain, shortness of breath and nausea, while monitors demonstrated tachypnea, a decrease in SaO2to 74%, and transient runs of VT. Administration of O2, IV lidocaine, and IV ephedrine, placement in the Trendelenburg position, and flooding the field with saline, gradually resolved the symptoms and led to delivery of a stable and normal infant. No air was aspirated from a central venous line. Post-operatively, there were some transient signs of pulmonary congestion and wheezing.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 17-year-old female underwent extensive orthopedic surgery of a knee under successful lumbar epidural anesthesia with lidocaine. Because significant pain was anticipated for several days postoperatively, continuous epidural infusion of fentanyl was planned. Following initial administration of 100 μg of fentanyl in saline, a continuous epidural infusion at 100 μg/h was initiated via a volumetric infusion pump. The pump tubing had 3 injection ports, with one port inadvertently left exposed. Several hours later an infusion of cephazolin (1 g in 50 ml of 5% D/W) was accidentally piggybacked into this exposed port rather than the intended IV tubing, with no awareness of this incident until 2 hours after its completion. The tubing was flushed with saline and changed. Fentanyl infusion was continued for an additional 24 hours without any evidence of short-term or long-term sequelae.

ISSN:0275-665X    

出版商:OVID    

年代:1990

数据来源: OVID